Osteopathic Principles & Practice – Part 2 25Mar2009

OPP #1 – Lower Extremities: Knee, Ankle, & Foot

1) Which of the following is an extensor, NOT a flexor of the knee joint?
a) Hamstrings (biceps femoris, semitendinosus, semimembranosus)
b) Gracilis
c) Sartorius
d) Popliteus
e) Gastrocnemius
f) Quadriceps femoris
2) Which of the following is the largest and most complicated articulation in the body?
a) Elbow
b) Knee
c) Ankle
d) Wrist
e) Foot
3) Regarding the femorotibial joint, the ____ meniscus is semicircular with its anterior
end attaching to the anterior intercondylar area in front of the ____ cruciate ligament.
a) Lateral; Posterior
b) Lateral; Anterior
c) Medial; Posterior
d) Medial; Anterior
4) The anterior cruciate ligament arises from the ____ and runs backward, upward, and
____ to insert on to the lateral femoral condyle.
a) Tibia; Lateral
b) Femur; Lateral
c) Tibia; Medial
d) Femur; Medial
5) The femoropatellar joint is a ____ joint (sellar joint, articulation by reciprocal
reception).
a) Ball and socket
b) Condyloid
c) Saddle
d) Hinge
e) Pivot
6) The posterior cruciate ligament arises from the ____ and runs forward and upward
obliquely to insert on to the lateral aspect of the ____ femoral condyle.
a) Tibia; Lateral
b) Femur; Lateral
c) Tibia; Medial
d) Femur; Medial
7) Normally, the knee flexes to ____ degrees, with extension being a return from flexion
to zero degrees.
a) 185
b) 135
c) 85
d) 35
e) 0

DO NOT DISTRIBUTE -1-

Osteopathic Principles & Practice – Part 2 25Mar2009

8) Which of the following is a dorsiflexor, NOT a plantarflexor?

a) Gastrocnemius
b) Soleus
c) Plantaris
d) Tibialis anterior
e) Flexor hallucis longus
9) Dorsiflexion is normally ____ degrees and plantarflexion is normally ____ degrees.
a) 20; 20
b) 50; 50
c) 20; 50
d) 50; 20
e) 90; 90
10) The Anterior Drawer Test (as well as the Lachman Maneuver) is used to test which of
the following ligaments?
a) Anterior cruciate ligament (ACL)
b) Posterior cruciate ligament (PCL)
c) Medial collateral ligament (MCL)
d) Lateral collateral ligament (LCL)
e) MCL and LCL
11) The Varus-Valgus Stress Test is used to test for which of the following ligaments?
a) Anterior cruciate ligament (ACL)
b) Posterior cruciate ligament (PCL)
c) Medial collateral ligament (MCL)
d) Lateral collateral ligament (LCL)
e) MCL and LCL
12) The Posterior Drawer Test is used to test which of the following ligaments?
a) Anterior cruciate ligament (ACL)
b) Posterior cruciate ligament (PCL)
c) Medial collateral ligament (MCL)
d) Lateral collateral ligament (LCL)
e) MCL and LCL
13) Which of the following gives a positive test (failure) if the knee cannot be extended
fully by pulling distally on the leg, indicating fluid within the knee joint?
a) External rotation (Recurvatum Test)
b) McMurray test
c) Apley Compression Test
d) Apley Distraction Test
e) Knee Joint Effusion Test (Bounce-Home Test)
f) Patella Femoral Grinding Test
14) Which of the following tests uses a valgus stress, adduction, and extension of the leg
to evaluate for meniscal tears?
a) External rotation (Recurvatum Test)
b) McMurray test
c) Apley Compression Test
d) Apley Distraction Test
e) Knee Joint Effusion Test (Bounce-Home Test)

DO NOT DISTRIBUTE -2-

Osteopathic Principles & Practice – Part 2 25Mar2009

f) Patella Femoral Grinding Test

15) Which of the following involves the patient being prone and the clinician pulling
distally on the leg and applying torsion to evaluate for medial or lateral ligamentous
dysfunction?
a) External rotation (Recurvatum Test)
b) McMurray test
c) Apley Compression Test
d) Apley Distraction Test
e) Knee Joint Effusion Test (Bounce-Home Test)
f) Patella Femoral Grinding Test
16) Which of the following involves the patient flexing their quadriceps while the
clinician pushes the patella caudad, checking for pain or crepitation to evaluate potential
chondromalacia of the patella?
a) External rotation (Recurvatum Test)
b) McMurray test
c) Apley Compression Test
d) Apley Distraction Test
e) Knee Joint Effusion Test (Bounce-Home Test)
f) Patella Femoral Grinding Test
17) Which of the following gives a positive test if the knee hyperextends with external
rotation of the tibia, indicating injury to the arcuate ligament, popliteus, and fibular
collateral ligaments?
a) External rotation (Recurvatum Test)
b) McMurray test
c) Apley Compression Test
d) Apley Distraction Test
e) Knee Joint Effusion Test (Bounce-Home Test)
f) Patella Femoral Grinding Test
18) Which of the following involves the patient being prone and the clinician pushing
downward on the leg and applying torsion to evaluate a medial meniscal tear?
a) External rotation (Recurvatum Test)
b) McMurray test
c) Apley Compression Test
d) Apley Distraction Test
e) Knee Joint Effusion Test (Bounce-Home Test)
f) Patella Femoral Grinding Test
19) Which of the following is most associated with lateral foot pain?
a) Cuboid
b) Calcaneus
c) Navicular
d) Talus
20) The most common type of ankle sprain represents an ____, with the ____ ankle
ligaments sustaining the initial impact.
a) Eversion; Lateral
b) Inversion; Lateral
c) Eversion; Medial

DO NOT DISTRIBUTE -3-

Osteopathic Principles & Practice – Part 2 25Mar2009

d) Inversion; Medial
21) The lateral longitudinal arch of the foot involves all of the following bones EXCEPT:
a) Cuboid
b) Calcaneus
c) 3rd metatarsal
d) 4th metatarsal
e) 5th metatarsal
22) The medial longitudinal arch (spring) of the foot involves all of the following bones
EXCEPT:
a) Calcaneus
b) Talus
c) Navicular
d) Cuneiforms
e) Metatarsals 1-4
23) Which of the following transverse arches of the foot has the five metatarsals as a
base?
a) Anterior metatarsal arch
b) Posterior metatarsal arch
c) Tarsal arch

OPP #2 – Psoas, Quadratus Lumborum, & Piriformis Syndrome

1) The quadratus lumborum muscle is innervated by all of the following EXCEPT:
a) T12
b) L1
c) L2
d) L3
e) L4
2) Referred pain from the quadruatus lumborum, such as during spasm, goes to where?
a) Middle of the back
b) Right shoulder
c) Hip and groin
d) Inguinal ligament
e) 12th rib
3) Where is the key non-neutral somatic dysfunction in psoas syndrome?
a) T11-T12
b) L1-L2
c) L3-L4
d) L5-S1
e) S2-S3
4) If the left psoas is in spasm (left oblique axis of sacrum), which of the following
somatic dysfunctions is present? FB = forward bending
a) FB RR SR
b) FB RR SL
c) FB RL SR
d) FB RL SL

DO NOT DISTRIBUTE -4-

Osteopathic Principles & Practice – Part 2 25Mar2009

5) The psoas muscle extends over the superior pubic ramus and under the inguinal
ligament, inserting on the ____ trocanter on the ____ side of the femur.
a) Greater; Medial
b) Greater; Lateral
c) Lesser; Medial
d) Lesser; Lateral
6) What nerves innervate the psoas muscle?
a) T12-L1
b) L2-L3
c) L4-L5
d) S1-S2
e) S3-S5
7) Which of the following would most likely cause psoas syndrome?
a) Slumping over in a soft chair
b) Sitting upright in a hard chair
c) Working at a desk and bending down quickly
d) Weeding in a garden and getting up quickly
e) Being rear-ended in a car
8) If the left oblique sacral axis is engaged and the spine is neutral (no flexion or
extension), there will be a ____ torsion. If the spine is non-neutral, there will be a ____
torsion.
a) Right forward; Right backward
b) Left forward; Left backward
c) Right backward; Right forward
d) Left backward; Left forward
9) If the left sacral oblique axis is engaged from a psoas spasm, the sacrum will rotate
right giving a shallow ____ sacral sulcus and a prominent ILA on the ____.
a) Left; Right
b) Right; Left
c) Left; Left
d) Right; Right
10) Psoas syndrome can cause external rotation of the ____ femur with short leg and
sciatic pain on the ____ side, due to piriformis involvement on that side.
a) Ipsilateral; Ispiateral
b) Contralateral; Contralateral
c) Ipsilateral; Contralateral
d) Contralateral; Ipsilateral
11) Stretching of a dysfunctional muscle (e.g. psoas) could induce a reflex spasm and
make the dysfunction worse.
a) True
b) False
12) Which of the following test for the presence of a flexion contracture of the hip?
a) Patrick test
b) McMurray test
c) Apley Test
d) Thomas test

DO NOT DISTRIBUTE -5-

Osteopathic Principles & Practice – Part 2 25Mar2009

e) Tinel test
13) The piriformis muscle originates from the anterior portion of the sacrum as well as
the sacrotuberous ligament, exits the pelvis through the ____ sciatic foramen, and inserts
on the ____ trochanter of the femur.
a) Greater; Lesser
b) Greater; Greater
c) Lesser; Greater
d) Lesser; Lesser
14) What percentage of the population (approximately) has the sciatic nerve passing
directly through the piriformis muscle?
a) 0-5%
b) 10-15%
c) 20-25%
d) 30-35%
e) 40-45%
15) Which of the following is not commonly associated with sciatica?
a) Pain down to the calf or foot
b) Pain down the posterior thigh
c) Buttocks pain
d) Hip pain
e) Low back pain
16) To test for asymmetry of the piriformis muscle, the clinician would ____ until
resistance is felt.
a) Internally rotate the hips
b) Externally rotate the hips
c) Internally rotate the knees
d) Externally rotate the knees

OPP #3 – Lumbar Muscle Energy

1) Who is credited with developing muscle energy techniques?
a) A. T. Still
b) P. S. Moran
c) N. A. Pruzzo
d) F. L. Mitchell, Jr.
e) F. L. Mitchell, Sr.
2) What classification is given to muscle energy techniques?
a) Direct
b) Indirect
c) Neutral
d) High velocity
e) Myofascial
3) Muscle energy techniques ____ muscle fibers and ____ hypertonicity.
a) Lengthen; Increase
b) Lengthen; Decrease
c) Shorten; Increase
d) Shorten; Decrease

DO NOT DISTRIBUTE -6-

Osteopathic Principles & Practice – Part 2 25Mar2009

4) Which of the following is defined as immediately following contraction, the

neuromuscular apparatus is in a refractory state during which passive stretching may be
performed without encountering strong myotatic reflex opposition?
a) Oculocervical (Oculogyric) teflex
b) Respiratory assist
c) Postisometric relaxation
d) Joint mobilization using muscle force
e) Reciprocal inhibition
5) Which of the following would involve contraction of an agonist (e.g. biceps) to relax
the antagonist muscles (e.g. triceps)?
a) Oculocervical (Oculogyric) teflex
b) Respiratory assist
c) Postisometric relaxation
d) Joint mobilization using muscle force
e) Reciprocal inhibition
6) Which of the following muscle energy contraindications is absolute and not relative?
a) Moderate to severe muscle strains
b) Advanced osteoporosis
c) Severe illness (e.g. myocardial infarction)
d) Severe joint instability at treatment site
e) Post-surgical patients
7) During muscle energy techniques, the barrier is engaged ____ the somatic dysfunction
diagnosis and the patient contracts ____ the freedom of motion.
a) Toward; Into
b) Toward; Away from
c) Away from; Into
d) Away from; Away form
8) Which of the following is the last step in a muscle energy technique?
a) Check for somatic dysfunction
b) Engage the barrier
c) Patient contracts
d) Allow for relaxation
e) Engage new barrier
9) What vertebral body is located at the level of the iliac crests?
a) L1
b) L2
c) L3
d) L4
e) L5
10) Flexion and extension are the major movements of lumbar vertebra as their facets are
lined in a ____ direction.
a) Backward and medial
b) Backward and lateral
c) Forward and medial
d) Forward and lateral

DO NOT DISTRIBUTE -7-

Osteopathic Principles & Practice – Part 2 25Mar2009

11) Because of the location of the latissimus dorsi insertion, hypertonicity in this muscle
can yield pain in which location?
a) Neck
b) Shoulder
c) Thoracic spine
d) Lumber spine
e) Chest
12) Hypertonicity of the gluteus maximus would yield pain in which regions?
a) Upper and middle back
b) Middle and lower back
c) Lower back and gluteals
d) Gluteals and thighs
e) Thighs and knees
13) Which of the following is NOT an attachment of quadratus lumborum?
a) Iliac crest
b) Iliolumbar ligament
c) Inguinal ligament
d) 12th rib
14) What is the action of the iliopsoas (psoas major and iliacus)?
a) Extends and internally rotates hip
b) Extends and externally rotates hip
c) Flexes and internally rotates hip
d) Flexes and externally rotates hip
15) Which of the following is the first to become tender with lumbar posture changes,
giving a tender area about 1” superior and lateral to the PSIS on the iliac crest?
a) Anterior longitudinal ligament
b) Posterior longitudinal ligament
c) Ligamentum flavum
d) Iliolumbar ligament
e) Sacroiliac ligament
16) Weakness in which of the following muscles would cause stress in the lumbar
region?
a) Abdominal muscles
b) Trapezius
c) Lattisimus dorsi
d) Gluteus maximus
e) Hamstrings
Match the following types of back pain with possible diagnoses:
17) Pain that wakes the patient from sleep a) Dissecting aortic aneurysm
18) Claudication symptoms with back pain b) Malignancy (tumor)
19) Sudden severe low back pain without trauma c) Epidural abscess
20) Rapidly progressing neurological defects d) Spinal stenosis
Match the term with the Fryette mechanics involved: a) Type I b) Type II
21) Flexed or extended
22) Single segment
23) Group segments

DO NOT DISTRIBUTE -8-

Osteopathic Principles & Practice – Part 2 25Mar2009

24) Sidebending and rotation in opposite directions

25) Neutral
26) Sidebending and rotation to same direction
27) Sidebending occurs in which plane of motion?
a) Ventral
b) Sagittal
c) Coronal
d) Transverse
e) Dorsal
28) When treating lumbar dysfunction with muscle energy, which of the following
positions is the setup for a flexion dysfunction?
a) Rotation side up, lateral Sims
b) Rotation side up, lateral recumbent
c) Rotation side down, lateral Sims
d) Rotation side down, lateral recumbent
29) When treating lumbar dysfunction with muscle energy, which of the following
positions is the setup for an extension dysfunction?
a) Rotation side up, lateral Sims
b) Rotation side up, lateral recumbent
c) Rotation side down, lateral Sims
d) Rotation side down, lateral recumbent
30) In a type II lumbar extension dysfunction, the clinician would push the patient’s legs
____. In a type I lumbar extension dysfunction, the clinician would push the patient’s
legs ____.
a) Down; Down
b) Down; Up
c) Up; Up
d) Up; Down
31) Which disease that can cause low back pain is also known as osteitis deformans?
a) Graves disease
b) Kawasaki disease
c) Alzheimer disease
d) Castleman disease
e) Paget disease

OPP #4 – Sacral Somatic Dysfunction

1) Which of the following does not fit with the rest of the sacral spring test descriptions?
a) Positive spring test
b) Sacroiliac dysfunction
c) Forward sacral dysfunction
d) Painful
2) For a forward sacral dysfunction (neutral), if a deep sulcus is found on the left and the
inferior lateral angle (ILA) is found posterior on the right, which of the following is the
dysfunction?
a) Unilateral sacral flexion left
b) Unilateral sacral flexion right

DO NOT DISTRIBUTE -9-

Osteopathic Principles & Practice – Part 2 25Mar2009

c) Left on left
d) Right on right
e) Bilateral sacral flexion
3) For a backward sacral dysfunction (non-neutral), if a shallow sulcus is found on the
left and the ILA is posterior on the right, which of the following is the dysfunction?
a) Unilateral sacral extension left
b) Unilateral sacral extension right
c) Left on right
d) Right on left
e) Bilateral sacral extension
4) Using alternative terminology, what is an anterior sacrum right?
a) Sacrum is rotated right and side-bent right
b) Sacrum is rotated left and side-bent left
c) Sacrum is rotated right and side-bent left
d) Sacrum is rotated left and side-bent right
5) What is posterior sacrum left?
a) Sacrum is rotated right and side-bent right
b) Sacrum is rotated left and side-bent left
c) Sacrum is rotated right and side-bent left
d) Sacrum is rotated left and side-bent right
6) Which of the following is NOT true with posterior sacrum left?
a) Right psoas spasm and short leg
b) Left piriformis spasm
c) Pelvic side-shift left
d) Pain at left ILA
e) Positive seated flexion right
7) Which of the following is true for a right sacral torsion?
a) L5 side-bending on right oblique axis, seated flexion test positive on right
b) L5 side-bending on right oblique axis, seated flexion test positive on left
c) L5 side-bending on left oblique axis, seated flexion test positive on right
d) L5 side-bending on left oblique axis, seated flexion test positive on left
8) In a primary care clinic, your next scheduled patient is complaining about groin pain
and headaches. You happen to notice the patient walking down the hall with an abnormal
gait and increased lordotic curve. Upon examination, there is no sacral flexion or
extension and a positive seated flexion test on the right. What is the diagnosis?
a) Sacrum left on left
b) Sacrum left on right
c) Sacrum right on right
d) Sacrum right on left
9) A patient presents with low back pain that they got while bowling. Upon examination,
L5 is rotated right. The sacral base has moved posteriorly (right pole). What is the
diagnosis?
a) Sacrum left on left
b) Sacrum left on right
c) Sacrum right on right
d) Sacrum right on left

DO NOT DISTRIBUTE - 10 -
Osteopathic Principles & Practice – Part 2 25Mar2009

10) Which of the following is true for a L5 F RR SR somatic dysfunction?

a) Left obique axis, sacrum rotates left, seated flexion positive on left
b) Right obique axis, sacrum rotates left, seated flexion positive on left
c) Right obique axis, sacrum rotates right, seated flexion positive on left
d) Right obique axis, sacrum rotates right, seated flexion positive on right
e) Right obique axis, sacrum rotates left, seated flexion positive on right
11) Which of the following is true for a L5 N RR SL somatic dysfunction?
a) Right obique axis, sacrum rotates left, seated flexion positive on left
b) Right obique axis, sacrum rotates right, seated flexion positive on left
c) Left obique axis, sacrum rotates left, seated flexion positive on left
d) Left obique axis, sacrum rotates right, seated flexion positive on right
e) Left obique axis, sacrum rotates left, seated flexion positive on right
12) A patient presents with low back pain shortly after giving birth. An increased lumbar
curve is found along with a negative spring test and bilateral posterior ILAs. A bilateral
sacral flexion dysfunction is diagnosed. Which sacral axis is being used for motion?
a) Vertical axis
b) Oblique axis
c) Superior transverse axis
d) Middle transverse axis
e) Anteroposterior axis
13) A patient presents with low back pain that gets worse with forward bending. A
bilateral sacral extension dysfunction is diagnosed. Which of the following is true?
a) Increased lumbar curve, negative spring test
b) Increased lumbar curve, positive spring test
c) Decreased lumbar curve, positive spring test
d) Decreased lumbar curve, negative spring test
14) In short leg syndrome, the deep sacral sulcus will be on the ipsilateral side.
a) True
b) False
15) When walking, the thoracic area initially rotates left. Then the lumbar area side-bends
left and there is torsional locking at the lumbosacral junction, as the body of the sacrum is
moving left. What happens to the vertical center of gravity?
a) It moves to the inferior pole of the left SI
b) It moves to the superior pole of the left SI
c) It moves to the inferior pole of the right SI
d) It moves to the superior pole of the right SI
16) When walking, as the right foot moves forward, the quadriceps on that side tense.
Which of the following is true?
a) There is tension on the inferior pole of the left SI
b) There is tension on the superior pole of the left SI
c) There is tension on the inferior pole of the right SI
d) There is tension on the superior pole of the right SI
17) During walking, the innominate moves anterior and posterior on what axis?
a) Oblique axis
b) Inferior transverse axis
c) Superior transverse axis

DO NOT DISTRIBUTE - 11 -
Osteopathic Principles & Practice – Part 2 25Mar2009

d) Middle transverse axis

e) Anteroposterior axis

OPP #5 – Thoracic Spine Somatic Dysfunction

1) The kyphotic curve is a primary (fetal) curve with mild, forward bending, that ____
with age, especially in ____.
a) Decreases; Men
b) Decreases; Women
c) Increases; Men
d) Increases; Women
2) Surgeons tend to avoid procedures in the area of the thoracic duct due to what other
anatomical structure?
a) Cisterna chyli
b) Ligamentum flavum
c) Sympathetic chain
d) Esophagus
e) Azygous vein
3) Which of the following is NOT a function of the muscle of the thoracic spine?
a) Posture
b) Breathing
c) Anchor for head/neck
d) Visceral function
e) Gross motion/lifting
4) A patient presents with myofascial pain when rotating or side-bending their neck. The
patient has an “uneasy” feeling in their stomach associated with this motion. Which of
the following muscles would most likely be involved?
a) Splenius cervicis
b) Internal oblique
c) External oblique
d) Erector spinae
e) Rotatores
5) The erector spinae group is often associated with ____ mechanics and the rotatores are
often associated with ____ mechanics as well as viscerosomatic reflexes.
a) Type I; Type I
b) Type I; Type II
c) Type II; Type I
d) Type II; Type II
6) In order to change parasympathetic tone in the thoracic area, what nerve should be
affected?
a) Phrenic
b) Trigeminal
c) Vagus
d) Facial
e) Long thoracic
7) A patient presents after surgery with increased sympathetic tone. Which of the
following techniques can be done to normalize sympathetic function?

DO NOT DISTRIBUTE - 12 -
Osteopathic Principles & Practice – Part 2 25Mar2009

a) Rib-raising
b) Cervical HVLA
c) Lumbar muscle energy
d) Ischial spread
e) Pedal pump (Dalrymple Technique)
Match the somatovisceral innervation with the associated organ(s):
8) Left colon a) T1-T4
9) Right colon b) T1-T6
10) Heart and lungs c) T5-T9
11) Head and neck d) T10-T11
12) Liver, gall bladder e) T12-L2
13) Pancreas, spleen
14) Stomach, duodenum
15) Uterus, gonads
16) Distal small bowel
17) Pelvic organs
18) What is the major type of motion in the upper thoracic vertebra?
a) Flexion
b) Extension
c) Rotation
d) Side-bending
19) What is the major type of motion in the lower thoracic vertebra?
a) Flexion
b) Extension
c) Rotation
d) Side-bending
20) What direction do the cervical facets face?
a) Backward, upward, medial
b) Backward, upward, lateral
c) Backward, medial
d) Backward, lateral
21) What direction do the thoracic facets face?
a) Backward, upward, medial
b) Backward, upward, lateral
c) Backward, medial
d) Backward, lateral
22) What direction do the lumbar facets face?
a) Backward, upward, medial
b) Backward, upward, lateral
c) Backward, medial
d) Backward, lateral
Match the type of Freyette mechanics with the thoracic vertebrae:
23) T1-T4 (upper) a) Type I
24) T5-T7 (middle) b) Type II
25) T8-T11 (lower) c) Mixed Type I, Type II
26) T12

DO NOT DISTRIBUTE - 13 -
Osteopathic Principles & Practice – Part 2 25Mar2009

27) A 21-year-old male patient presents with a deformed sternum and desire to have
cosmetic surgery. It appears that the sternum is sunken into the chest and exam reveals
scoliosis. History reveals cardiac and respiratory problems. A CT scan is ordered to
obtain a Haller index prior to performing a surgical Nuss procedure. Which of the
following does this patient have?
a) Pectus excavatum
b) Pectus carinatum
c) Marfan Syndrome
d) Poland Syndrome
e) Morquito Syndrome
Match the vertebral levels with the anatomical location:
28) Inferior scapular angle a) T2
29) Scapular spine b) T3
30) Xiphosternal angle c) T4
31) Sternal notch d) T7
32) Sternal angle e) T9
33) Which of the following is a palpatory feature of acute somatic dysfunction?
a) Cold
b) Dry
c) Stringy
d) Boggy
e) Ropey
34) A patient presents with pulmonary problems. When testing for somatic dysfunction,
you find that the chest rises evenly during inhalation. However, during exhalation the
right side drops normally and the left side is delayed. You find that ribs 2-6 are involved.
What rib is the key rib for manipulative treatment?
a) Left rib 2
b) Right rib 2
c) Left rib 6
d) Right rib 6
35) What ribs produce mostly bucket handle motion?
a) 1, 2, 10, 11, 12
b) 11-12
c) 1-6
d) 7-10
e) 3-5
36) Which of the following is NOT involved in typical osteopathic treatment?
a) Medications
b) Medical procedures
c) Surgery
d) OMT
e) Acupuncture
37) Which of the following is considered a typical rib?
a) 1
b) 9
c) 10

DO NOT DISTRIBUTE - 14 -
Osteopathic Principles & Practice – Part 2 25Mar2009

d) 11
e) 12
38) The diaphragm is responsible for at least what percentage of change in pressure
within the thoracic cage?
a) 20%
b) 40%
c) 60%
d) 80%
e) 100%
39) A patient is being treated for 11-12 rib exhalation somatic dysfunction. During
inhalation, the physician instructs the patient to pull the right ASIS down toward the table
while the physician’s right hand resists. At the same time, the left hand exaggerates the
inhalation motion be exerting force in what directions?
a) Medial
b) Lateral
c) Lateral and caudad
d) Lateral and cephalad
e) Medial and caudad
40) A patient presents with shortness of breath. Examination reveals 7th rib exhalation
dysfunction. Which of the following should be used to treat this patient?
a) Serratus anterior, long thoracic nerve
b) Serratus anterior, medial pectoral nerve
c) Pectoralis minor, medial pectoral nerve
d) Latissimus dorsi, thoracodorsal nerve
e) Pectoralis minor, thoracodorsal nerve
Match the ribs with their muscular attachments:
41) Ribs 6-8 a) Posterior scalene
42) Rib 1 b) Anterior/middle scalenes
43) Rib 2 c) Pectoralis minor
44) Rib 12 d) Quadratus lumborum
45) Ribs 3-5 e) Latissimus dorsi
46) Ribs 9-11 f) Serratus anterior

OPP #6 – Self Esteem & “Healer’s Touch”

1) Secondary self esteem is described as:
a) Perceived successes and achievements
b) Perception of one’s value from significant others
c) Positive physical appearance and high value
d) Achievements and abilities
2) Which of the following would be used to describe the dialogue, “I am not going to be a
good doctor because I do not know as much as Dr. Jan. I might as well give up now.”
a) Overly self critical
b) Overgeneralization
c) Looking glass self
d) Catastrophizing

DO NOT DISTRIBUTE - 15 -
Osteopathic Principles & Practice – Part 2 25Mar2009

3) Which of the following relationship pillars involves opening up to risks and

vulnerabilities and can result in indifference, rejection, or betrayal?
a) Self-disclosure
b) Need fulfillment
c) Commitment ability
d) Conflict management
e) Commutation
4) Which of the following can be described in the Vince Lombardi quote, “The harder
you work, the harder it is to surrender?”
a) Conflict management
b) Need fulfillment
c) Commutation
d) Self-disclosure
e) Commitment ability
5) Which of the following is an example of healthy conflict, which does not bring about
the issues of power and control?
a) Double standards
b) Motivation to participate
c) Economic inequities
d) Intimidation and name calling
e) Manipulation or isolation
6) If a clinician is talking with a patient, but the clinician does not have enough self-
esteem to give their opinion, what communication role are they taking?
a) Parent
b) Adult
c) Child
7) Relationships with others are primarily:
a) Altruistic
b) Demanding
c) Love-inducing
d) Need-based
e) Wanting
8) Which of the following involves the ends justifying the means and may lead to
retaliation?
a) Win-win collaboration
b) Compromise
c) Lose-win collaboration
d) Win-lose collaboration
e) No winners, no losers
9) Which of the following can be described as “discretion being the better part of valor?”
a) Win-win collaboration
b) Compromise
c) Lose-win collaboration
d) Win-lose collaboration
e) No winners, no losers

DO NOT DISTRIBUTE - 16 -
Osteopathic Principles & Practice – Part 2 25Mar2009

10) A word someone might use to describe how they feel about two unrelated things that
elicit very different emotions is:
a) Anger
b) Fear
c) Happy
d) Love
e) Sad
11) In order to ensure that the receiver of a message understand what is meant, which of
the following must take place?
a) Appreciation
b) Back talk
c) Collaboration
d) One-way communication
e) Reflective listening
12) Effective physician-patient communication has been associated with reduced risk of
malpractice lawsuits.
a) True
b) False, lawsuits always depends on whether malpractice took place
13) Which of the following is a new field of medicine involving
psychoneuroimmunology?
a) The power of the mind
b) Guided imagery
c) Meditation
d) Shamanism
e) Hypnosis
14) Which of the following is recognized as a door to the unconscious mind and was first
called “animal magnetism” by Franz Anton Mesmer?
a) The power of the mind
b) Guided imagery
c) Meditation
d) Shamanism
e) Hypnosis
15) Which of the following is a way to calm the mind and body and has been defined by
some as “listening to God.”
a) The power of the mind
b) Guided imagery
c) Meditation
d) Shamanism
e) Hypnosis
16) Which of the following has been described by Dr. Martin Rossman as “a window to
your inner world” and involves communication between emotion and bodily change?
a) The power of the mind
b) Guided imagery
c) Meditation
d) Shamanism
e) Hypnosis

DO NOT DISTRIBUTE - 17 -
Osteopathic Principles & Practice – Part 2 25Mar2009

17) Which of the following is an alternative approach in which the “mind and spirit can
be awakened?”
a) The power of the mind
b) Guided imagery
c) Meditation
d) Shamanism
e) Hypnosis
18) Which of the following people has written on the effects of spirituality, prayer, and
the healing process as well as conducting double-blind studies on these topics?
a) Padre Pio
b) Martin Rossman, MD
c) Larry Dossey, MD
d) Benedict Lust
e) John Upledger, DO
f) Jan Hendryx, DO
19) In the book “Healer’s Touch,” by Jan Hendryx, DO, the author suggests adding an
additional year of medical school and shifting focus away from which of the following
courses?
a) Manipulative medicine
b) Biochemistry
c) Anatomy
d) Physiology
e) Pharmacology
20) What technique was created by Dr. Upledger, DO and Dr. Rossman, MD?
a) Muscle energy
b) Cranial osteopathy
c) HVLA manipulation
d) Somatoemotional release
e) Creative visualization and guided imagery
21) In the book “Healer’s Touch,” by Jan Hendryx, DO, A.T. Still says the human being
is composed of all of the following EXCEPT:
a) Mind
b) Body
c) Spirit
d) DNA
22) What is the underlying commonality of all neurotic disorders, such as OCD, phobias,
and anxiety?
a) Anger
b) Fear
c) Happiness
d) Love
e) Sadness
23) Which of the following is NOT a defense mechanism described by Sigmund Freud in
regard to Western ego (fear-based reality)?
a) Acceptance
b) Denial

DO NOT DISTRIBUTE - 18 -
Osteopathic Principles & Practice – Part 2 25Mar2009

c) Distortion
d) Repression
e) Projection
24) Andrew Jackson Davis expressed that the root cause of all illness begins with the:
a) Mind
b) Body
c) Spirit

OPP #7 – Relaxation Techniques

1) Which of the following is NOT a benefit of relaxation?
a) Restorative energy
b) Decrease distressing reactions
c) Creates a receptive mental and physical state
d) Prepares the body and mind for activity
e) Increases sympathetic tone
2) Which of the following, described by J. H. Schultz, is described as a relaxation state of
feeling “warmth” and “heaviness”?
a) Functional relaxation
b) Autogenic relaxation
c) Progressive muscle relaxation
d) Jacobsonian relaxation
e) Fantasy
3) Which of the following involves tensing a muscle group tightly and holding, then
going limp and repeating with another muscle group?
a) Functional relaxation
b) Autogenic relaxation
c) Progressive muscle relaxation
d) Jacobsonian relaxation
e) Fantasy
4) Which of the following is the only human act that can be done either completely
consciously or unconsciously?
a) Walking
b) Thinking
c) Breathing
d) Smelling
e) Hearing
5) One-third of people breathe ineffectively, which can lead to:
a) Cardiovascular disorders
b) Mood disorders
c) Immune disorders
d) Digestive problems
e) All of the above
6) Which of the following is a Sanskrit term for universal life force or breath, which can
be enhanced by yoga?
a) Pneuma
b) Prana

DO NOT DISTRIBUTE - 19 -
Osteopathic Principles & Practice – Part 2 25Mar2009

c) Anima spiritus
d) Ki
e) Rauch
7) The “Relaxing Breath” exercise for breathing involves breathing in for ____ seconds,
holding the breath for ____ seconds, and breathing out over ____ seconds in an attempt
to calm the sympathetic nervous system.
a) 2; 3; 4
b) 3; 6; 9
c) 4; 7; 8
d) 4; 6; 11
e) 7; 4; 8
8) Which of the following exercises involves flexing a muscle group then slowly
releasing the tension, which usually starts from the cephalad muscles going down to the
caudad muscles?
a) Functional relaxation
b) Autogenic relaxation
c) Progressive muscle relaxation
d) Jacobsonian relaxation
e) Fantasy
9) Rehearsal is important in which of the following techniques?
a) Functional relaxation
b) Autogenic relaxation
c) Progressive muscle relaxation
d) Jacobsonian relaxation
e) Fantasy
10) Which of the following would involve picturing oneself in a tranquil environment
with positive surroundings to promote relaxation?
a) Autogenic relaxation
b) Guided imagery
c) Jacobsonian relaxation
d) Shamanism
e) Hypnosis

OPP #8 – Meditation
1) Which of the following is described as focusing the mind and paying attention?
a) Autogenic relaxation
b) Guided imagery
c) Jacobsonian relaxation
d) Meditation
e) Hypnosis
2) Benson (1975) developed which of the following?
a) Transcendental Meditation (TM)
b) Clinically Standardized Meditation (CSM)
c) Respiratory One Method (ROM)
d) Tai Chi
e) Zen Meditation

DO NOT DISTRIBUTE - 20 -
Osteopathic Principles & Practice – Part 2 25Mar2009

3) Which of the following was developed by Carrington, et. al. (1978)?

a) Transcendental Meditation (TM)
b) Clinically Standardized Meditation (CSM)
c) Respiratory One Method (ROM)
d) Mindfulness Meditation
e) Zen Meditation
4) Which of the following would be helpful for children who have difficulty sitting still?
a) Transcendental Meditation (TM)
b) Clinically Standardized Meditation (CSM)
c) Respiratory One Method (ROM)
d) Mindfulness Meditation
e) Zen Meditation
5) Which of the following is a sound or phrase that is repeated verbally or silently that
focuses the mind and allows one to enter into and remain in a meditative state?
a) Chant
b) Word
c) Prayer
d) Saying
e) Mantra
6) Which of the following is NOT true of the effects of meditation?
a) Increased sympathetic activity
b) Increased alpha (8-14 Hz) and theta (5-7 Hz) brainwave activity
c) Decreased beta (15-25 Hz) brainwave activity
d) Decreased blood lactate (stress)
e) Increased Dehydroepiandrosterone Sulfate (DHEA-S)
7) Which of the following is NOT true of the effects of meditation?
a) Balances autonomic nervous system
b) Decreases pain
c) Increase use of addictive substances
d) Improves mood disorders
e) Reduces blood pressure
8) During meditation, the focus should be on:
a) Improving delta brainwaves
b) Keeping your eyes closed
c) Breathing
d) Fantasizing
e) Departing from your body

OPP #9 – Facilitated Positional Releases

1) Who developed Facilitated Positional Release (FPR) in 1990, termed “instant
osteopathy?”
a) A. T. Still
b) S. Schiowitz
c) E. DiGiovanna
d) F. L. Mitchell, Jr.
e) F. L. Mitchell, Sr.

DO NOT DISTRIBUTE - 21 -
Osteopathic Principles & Practice – Part 2 25Mar2009

2) FPR is a(n) ____ myofascial technique with treatment taking ____ second(s).
a) Direct; 1
b) Indirect; 1
c) Direct; 3-5
d) Indirect; 3-5
3) Which of the following is considered a relative, not absolute contraindication for FPR?
a) Metastatic cancer
b) Cervical joint instability
c) Ankylosing spondylitis
d) Herniated disc
e) Cervical fracture
4) What is the physiological goal of FPR?
a) Increase discharge rate of type 1a sensory fibers (muscle spindle)
b) Stop discharge from type 1a sensory fibers (muscle spindle)
c) Increase discharge rate of type 1b sensory fibers (Golgi tendon organ)
d) Stop discharge from type 1b sensory fibers (Golgi tendon organ)
5) Before a compressive force is used, how should the cervical spine be positioned for
FPR?
a) Rotated toward dysfunction
b) Rotated away from dysfunction
c) Sidebent toward dysfunction
d) Sidebent away from dysfunction
e) Neutral
6) A patient presents with numbness in their lateral forearm, thumb, and index finger.
What nerve root is involved?
a) C5
b) C6
c) C7
d) C8
e) T1
7) A patient presents with a diminished triceps reflex. What nerve root is involved?
a) C5
b) C6
c) C7
d) C8
e) T1
8) When using the Spurling test for cervical radiculopathy secondary to nerve root
compression, how should the test be performed?
a) Extend neck, sidebend to side of pain, compress head
b) Extend neck, sidebend away from side of pain, compress head
c) Flex neck, sidebend to side of pain, compress head
d) Flex neck, sidebend to side of pain, add traction to head
e) Flex neck, sidebend away from side of pain, rotate toward side of pain
9) The Wallenberg test involves having the patient flex, extend, and rotate their head at
intervals of 10 seconds while checking for light-headedness, nystagmus, or visual
changes. What does this test for?

DO NOT DISTRIBUTE - 22 -
Osteopathic Principles & Practice – Part 2 25Mar2009

a) Nerve root lesion

b) Cervical radiculopathy
c) Vertebral artery insufficiency
d) Cervical thrombi or blocked lymph flow
e) Seizure disorders
10) During a muscle strength test, which of the following is described as movement
against gravity without resistance?
a) 1 of 5
b) 2 of 5
c) 3 of 5
d) 4 of 5
e) 5 of 5
11) A patient presents with an upper motor neuron (UMN) lesion due to a stroke. Deep
tendon reflexes show sustained clonus, a grading of:
a) +0 of 4
b) +1 of 4
c) +3 of 4
d) +3 of 4
e) +4 of 4
12) Damage to the C5 nerve root would show weakness in which of the following?
a) Interossei
b) Triceps brachii
c) Biceps brachii
d) Deltoid
e) Finger flexion
13) Which of the following is NOT one of the National Emergency X-Radiography
Utilization Study (NEXUS) Low Risk Criteria (NLC) for ruling out spinal x-ray?
a) No posterior midline cervical-spine tenderness
b) No evidence of intoxication
c) Altered level of alertness
d) No focal neurologic deficit
e) No painful distracting injuries

OPP #10 – Nutrition

1) Females are how much more likely to die of heart disease than breast cancer?
a) 2x
b) 3x
c) 4x
d) 8x
e) 24x
2) What is the third leading cause of death (2008) in the United States?
a) Cardiovascular
b) Cancer
c) Iatrogenic
d) Malnutrition
e) Obesity

DO NOT DISTRIBUTE - 23 -
Osteopathic Principles & Practice – Part 2 25Mar2009

3) The “Typical American Diet” is high in which of the following?

a) Fiber
b) Protein
c) Calcium
d) Potassium
e) Vitamins
4) Which of the following is NOT characteristic of a plant-based diet?
a) Decreased cholesterol
b) Protects against coronary artery disease
c) Protects against cancer
d) Protects against chronic disease
e) Prevents alkaline and crystal urine when taking high doses of ciprofloxacin
5) Which of the following would more likely be seen in an affluent population?
a) Cancer
b) Tubeculosis
c) Parasites
d) Pneumonia
e) Rheumatic heart disease
6) In the Indian Aflatoxin Study, rats were fed aflatoxin (Aspergillus mycotoxin) as part
of their diet. The incidence of liver cancer increased from 0% to 100% when which
substance in the rat’s diet was increased from 5% to 20%?
a) Protein
b) Fat
c) Sodium
d) Calcium
e) Growth hormone
7) Foci response would be the greatest in a diet consisting of what type of protein?
a) 20% casein
b) 20% gluten
c) 5% casein
d) 5% gluten
e) 5% gluten, 5% casein
8) Adequate protein for body growth consists of what percentage of daily calories?
a) 4%
b) 6%
c) 8%
d) 10%
e) 12%
f) 14%
g) 20%

OPP #11 – High Velocity Low Amplitude Thrust Technique

1) Which of the following did A. T. Still stress to his students?
a) Memorizing his techniques
b) Understanding pharmacology
c) Understanding anatomy

DO NOT DISTRIBUTE - 24 -
Osteopathic Principles & Practice – Part 2 25Mar2009

d) Understanding biochemistry
e) Being compassionate
2) The cavitation theory describes the HVLA mechanism as:
a) Change in lymphatic fluid to a gaseous state
b) Change in circulatory fluid to a gaseous state
c) Change in synovial fluid to a gaseous state
d) Movement of trapped air from inside the vertebral disks
e) The presence of a linear radiolucency in the disk space
3) The presence of a cracking or popping sound during HVLA treatment is indicative of
successful treatment.
a) True
b) False
4) HVLA is considered what type of technique?
a) Active and direct
b) Active and indirect
c) Passive and indirect
d) Passive and direct
5) Proper force during HVLA is in the direction of normal spinal motion (flex/extend or
side-bend).
a) True
b) False, an oblique force is used
6) The action applied during HVLA is a “forceful thrust.”
a) True
b) False, the force is a “nudge”
7) Which of the following complications has been associated with cervical manipulation,
with hyperextension seeming to be associated?
a) Nerve root lesion
b) Cervical radiculopathy
c) Vertebral artery insufficiency
d) Blocked lymph flow
e) Vertebral basilar thrombosis
8) Dens dislocation due to rupture or laxity of the transverse ligament of the atlas is
associated with which of the following?
a) Down syndrome
b) Marfan syndrome
c) Beçhet disease
d) Kienbock disease
e) Wolff-Parkinson-White syndrome
9) Which of the following is true of the occipitoatlantal (OA) joint?
a) Type I mechanics
b) Type II mechanics
c) Type I-like mechanics
d) Type II-like mechanics
10) While palpating the articular pillars of a patient, you feel your left hand go in deeper
at the level of C3. The depth evens out with extension. Which of the following is true?
a) C3 E SBR RR

DO NOT DISTRIBUTE - 25 -
Osteopathic Principles & Practice – Part 2 25Mar2009

b) C3 E SBR RL
c) C3 E SBL RR
d) C3 E SBL RL
e) C3 F SBR RR

OPP #12 – Cervical HVLA

Match the following Osteopathic events with their date:
1) Death of A.T. Still a) 1828
2) The California Experience b) 1874
3) A.T. Still “flung the banner of osteopathy to the breeze” c) 1892
4) American School of Osteopathy opens in Kirksville d) 1917
5) Birth of A.T. Still e) 1961
6) When palpating down (caudad) from the occiput posteriorly, what is the first vertebral
spinous process that can be felt?
a) C1
b) C2
c) C3
d) C7
e) T1
7) What is the primary motion of the occipitoatlantal joint?
a) Rotation
b) Flexion-extension
c) Side-bending
d) Lateral translatory
8) Which of the following motions would narrow intervertebral foramen and thus help
recreate a cervical radiculopathy?
a) Side-bending
b) Rotation
c) Flexion
d) Extension
e) Lateral translatory
9) The joints of Luschka (unciform joints) are developed at age 8 to 10 years and are
meant to prevent subluxation by limiting what type of motion?
a) Side-bending
b) Rotation
c) Flexion
d) Extension
e) Lateral translatory
10) What vertebral process should be monitored when doing gross motion testing of the
cervical spine for flexion and extension?
a) C1
b) C2
c) C3
d) C7
e) T1
f) None of the above

DO NOT DISTRIBUTE - 26 -
Osteopathic Principles & Practice – Part 2 25Mar2009

11) During OA examination, the left sulcus is felt deeper than the right and its depth
increases with flexion. The two sulci are most symmetrical in extension of the occiput.
What is the diagnosis?
a) OA F RR SBL
b) OA E RR SBL
c) OA F RL SBR
d) OA E RL SBR
12) Which of the following procedures would correctly diagnosis an atlantoaxial (AA)
joint rotated right somatic dysfunction?
a) Flex patient’s head 45 degrees, rotate both directions with restriction found on
patient’s left side
b) Flex patient’s head 45 degrees, rotate both directions with restriction found on
patient’s right side
c) Maintain patient’s head in a neutral position, rotate both directions with
restriction found on patient’s left side
d) Maintain patient’s head in a neutral position, rotate both directions with
restriction found on patient’s right side
13) If the posteriorly rotated articular pillar of C4 was palpated on the right and the
rotation became worse in flexion and more symmetrical in extension, what would be the
diagnosis?
a) C4 F RL SBL
b) C4 E RL SBL
c) C4 F RR SBR
d) C4 E RR SBR
14) When doing high velocity low amplitude (HVLA) thrusting techniques of the cervical
spine, which of the following types of motion should never be used as a set-up prior to, or
during a technique?
a) Flexion
b) Extension
c) Rotation
d) Side-bending
e) Distraction
15) If a patient is found to have an OA E SBL RR dysfunction, what general direction
would the thrusting motion be performed during HVLA treatment?
a) Sidebending to the left
b) Sidebending to the right
c) Rotation to the left
d) Rotation to the right
e) Extension
16) During HVLA treatment of the OA joint, where should the thrusting force be directed
towards?
a) Ipsilateral ASIS
b) Contralateral ASIS
c) Ipsilateral shoulder
d) Contralateral shoulder
e) Ipsilateral eye

DO NOT DISTRIBUTE - 27 -
Osteopathic Principles & Practice – Part 2 25Mar2009

f) Contralateral eye
17) During cervical spine thrusting maneuvers, the clinician should use what part of their
hand to monitor the dysfunctional joint?
a) Carpometacarpal (CMC)
b) Metacarpophalangeal (MCP)
c) Proximal interphalangeal (PIP)
d) Distal interphalangeal (DIP)
18) What type of thrusting motion is commonly used for HVLA of the AA joint as well
as the typical cervical vertebrae (C3-C7)?
a) Flexion
b) Extension
c) Rotation
d) Side-bending
e) Distraction

OPP #13 – Lumbar & Cervical HVLA + Review of Sacral & Pelvic Diagnosis
1) In the standard thrusting (HVLA) technique for treating lumbar somatic dysfunction
(e.g. “Lumbar Roll”), the patient is placed in a lateral recumbent position with the
posteriorly rotated transverse process facing ____ and the top foot ____.
a) Up; In the popliteal fossa
b) Down; In the popliteal fossa
c) Up; Off the table
d) Down; Off the table
2) Which of the following best describes the thrust used during the standard lumbar
HVLA technique?
a) The chest is rotated toward the clinician
b) The chest is rotated away from the clinician
c) The hip is rotated toward the clinician
d) The hip is rotated away from the clinician
3) Which of the following lists the minimal testing needed for sacral diagnosis?
a) Deep sulcus and Stork test
b) Deep sulcus and posterior ILA
c) Deep sulcus, posterior ILA, and spring test
d) Spring test and posterior ILA
e) Spring test, Stork test, deep sulcus, and posterior ILA
4) A standing flexion test is performed on a patient and it is positive on the right. A
seated flexion test reveals no change between posterior superior iliac spines (PSIS).
Which of the following best describes the dysfunction?
a) Right innominate dysfunction
b) Right sacral dysfunction
c) Right innominate dysfunction with possible sacral dysfunction
d) Right sacral dysfunction with possible innominate dysfunction
e) No somatic dysfunction
5) During innominate examination, the left ASIS is found to be lower than the right, the
right PSIS is found to be higher than the left, and the left pubic tubercle is found to be
caudad. Which of the following best describes the dysfunction?

DO NOT DISTRIBUTE - 28 -
Osteopathic Principles & Practice – Part 2 25Mar2009

a) Left anterior (rotated) innominate

b) Left posterior (rotated) innominate
c) Left superior shear
d) Right superior shear
e) Right posterior (rotated) innominate
6) In the thrusting (HVLA) technique for treating sacral somatic dysfunction that is
similar to lumber HVLA (e.g. “sacral L6”), the patient is placed in a lateral recumbent
position with the posteriorly rotated transverse process facing ____ and the top foot ____.
a) Up; In the popliteal fossa
b) Down; In the popliteal fossa
c) Up; Off the table
d) Down; Off the table
7) In the sacral “C” HVLA technique (“sacral smiley” or “Chicago technique”), the
patient is placed supine with the shallow sulcus facing ____ the clinician and the patient’s
hip slid ____ the clinician.
a) Toward; Toward
b) Toward; Away from
c) Away from; Away from
d) Away from; Toward

OPP #14 – Thoracic & Rib HVLA

1) In the standard thrusting (HVLA) technique for thoracic dysfunction (e.g. “Kirksville
Krunch”), the clinician places their ____ directly posterior to the patient’s ____.
a) Knuckles; Spinous processes
b) Knuckles; Transverse processes
c) Thenar eminence; Spinous processes
d) Thenar eminence; Transverse processes
2) When doing the standard thrusting technique for a patient who has T4-T6 RR SBL, the
clinician would be on the ____ side of the patient and the patient’s arms would be crossed
with their ____ arm placed more cephalad.
a) Left; Left
b) Right; Left
c) Left; Right
d) Right; Right
3) In the thrusting (HVLA) technique for treating T12 somatic dysfunction that is similar
to lumber HVLA, the patient is placed in a lateral recumbent position with the posteriorly
rotated transverse process facing ____ and the top foot ____.
a) Up; In the popliteal fossa
b) Down; In the popliteal fossa
c) Up; Off the table
d) Down; Off the table
4) Translation of the rib cage can best be used to diagnose which of the following?
a) T12 rotation
b) T12 side-bending
c) L1 rotation
d) L1 side-bending

DO NOT DISTRIBUTE - 29 -
Osteopathic Principles & Practice – Part 2 25Mar2009

5) Thoracic vertebra T12, like the rest of the lower thoracic vertebral processes, follows
type I mechanics.
a) True
b) False, T12 follows type II mechanics
c) False, lower thoracic vertebral processes follow type II mechanics
6) In the prone thoracic thrusting (HVLA) technique (e.g. “Texas Twist”), the clinician
places their hands on the ipsilateral side of the ____ diagnosis with the hand facing ____.
a) Rotational; Cephalad
b) Rotational; Caudad
c) Side-bending; Cephalad
d) Side-bending; Caudad
7) Where is the prone thoracic thrusting technique the least effective?
a) T1-T3
b) T4-T6
c) T7-T9
d) T10-T12
e) T12
8) HVLA of a posterior rib is most similar to which of the following?
a) Prone thoracic thrusting technique
b) Standard thoracic thrusting technique
c) Standard lumbar thrusting technique
d) Sacral C thrusting technique
e) T12 thrusting technique
f) Seated thoracic thrusting technique
9) In the thrusting (HVLA) technique for a raised first rib, the clinician uses their ____
metacarpophalangeal joint to apply a ____ thrust.
a) Contralateral; Rotational
b) Contralateral; Downward
c) Ipsilateral; Rotational
d) Ipsilateral; Downward
10) In the thrusting technique for a raised rib, the patient places their contralateral arm
over the clinician’s knee and sidebends their body away from the side of the raised rib.
The clinician then side-bends the patient’s head ____ the raised rib and rotates the head
____ the raised rib.
a) Toward; Toward
b) Toward; Away from
c) Away from; Away from
d) Away from; Toward
11) When treating thoracic inlet dysfunction with a raised rib using HVLA, the side-
bending aspect is treated on the ____ side by thrusting toward the ____, and the rotational
aspect is treated on the ____ side by thrusting toward the ____.
a) Contralateral; Contralateral ASIS; Ipsilateral; Contralateral shoulder
b) Ipsilateral; Contralateral ASIS; Contralateral; Contralateral shoulder
c) Contralateral; Contralateral shoulder; Ipsilateral; Contralateral ASIS
d) Ipsilateral; Contralateral shoulder; Contralateral; Contralateral ASIS

DO NOT DISTRIBUTE - 30 -
Osteopathic Principles & Practice – Part 2 25Mar2009

OPP #15 – Lumbar, Pelvic, & Sacral HVLA

1) In the standard technique for treating an anterior iliac dysfunction, the patient is placed
with the dysfunction side up and their top foot ____. A thrusting force is applied ____ to
the long axis of the femur.
a) In the popliteal fossa; Perpendicular
b) In the popliteal fossa; Parallel
c) Off the table; Perpendicular
d) Off the table; Parallel
2) In the standard technique for treating a posterior iliac dysfunction, the patient is placed
with the dysfunction side up and their top foot ____. A thrusting force is applied ____ to
the long axis of the femur.
a) In the popliteal fossa; Perpendicular
b) In the popliteal fossa; Parallel
c) Off the table; Perpendicular
d) Off the table; Parallel
3) In the leg pull technique (HVLA) for iliosacral dysfunction, placing the patient prone
and elevating the right leg off the table would be the set-up to treat what type of
dysfunction?
a) Superior shear
b) Anterior (rotated) innominate
c) Posterior (rotated) innominate
d) Left on left sacrum
e) Right on left sacrum
4) In the leg-pull technique for iliosacral dysfunction, placing the patient supine and
dropping the left leg off the table would be the set-up to treat what type of dysfunction?
a) Superior shear
b) Anterior (rotated) innominate
c) Posterior (rotated) innominate
d) Left on left sacrum
e) Right on left sacrum
f) Right on right sacrum
5) When treating pubic restriction with a thrusting (HVLA) technique, the patient is
placed in what position?
a) Supine with legs flexed, adducted, and internally rotated
b) Prone with legs flexed, abducted, and externally rotated
c) Supine with legs flexed, abducted, and internally rotated
d) Prone with legs flexed, adducted, and internally rotated
e) Supine with legs flexed, abducted, and externally rotated

OPP #16 – Extremity HVLA

1) When treating the commonly seen case of posterior (dorsal) carpal dysfunction with
HVLA, the wrist is placed in ____ and the thrust is performed by pushing ____.
a) Hyperflexion; Downward
b) Hyperextension; Downward
c) Hyperflexion; Upward
d) Hyperextension; Upward

DO NOT DISTRIBUTE - 31 -
Osteopathic Principles & Practice – Part 2 25Mar2009

2) If a patient loses the ability to passively supinate, this dysfunction can be named:
a) Anterior radial head or supination dysfunction
b) Posterior radial head or supination dysfunction
c) Anterior radial head or pronation dysfunction
d) Posterior radial head or pronation dysfunction
3) If a patient falls forward onto an outstretch hand, what type of dysfunction will most
likely occur?
a) Anterior radial head
b) Posterior radial head
4) When treating a posterior radial head with a thrusting (HVLA) technique, the patient’s
arm is ____ and ____ during the thrusting.
a) Pronated; Hyperflexed
b) Pronated; Hyperextended
c) Supinated; Hyperflexed
d) Supinated; Hyperextended
5) When treating a posterior tibial head, the patient is placed in a ____ position and the
____ of the patient’s foot is placed on the physician’s shoulder.
a) Prone; Sole
b) Prone; Dorsum
c) Supine; Sole
d) Supine; Dorsum
6) What is the normal range of motion for flexion of the knee joint?
a) 10 degrees
b) 75 degrees
c) 90 degrees
d) 115 degrees
e) 135 degrees
7) Which of the following describes a condition where the knees are bent inward toward
each other (“knock-knees”)?
a) Genu valgus
b) Genu varus
c) Genu recurvatum
8) When treating an anterior fibular head dysfunction with HVLA, the leg is ____ rotated
and the thrust is performed downward and outward during ____.
a) Externally; Flexion
b) Externally; Extension
c) Internally; Flexion
d) Internally; Extension
9) Loss of dorsiflexion of the foot would be diagnosed as:
a) Anterior talus dysfunction
b) Posterior cuboid dysfunction
c) Anterior tibia dysfunction
d) Posterior fibula dysfunction
10) A patient presents with pain on the lateral plantar aspect of the foot proximal to the
styloid process of the fifth metatarsal with pain upon inversion. Which of the following is
most likely?

DO NOT DISTRIBUTE - 32 -
Osteopathic Principles & Practice – Part 2 25Mar2009

a) Talus dysfunction
b) Navicular dysfunction
c) Cuboid dysfunction
d) Cuneiform dysfunction
e) Tarsal dysfunction
11) If a patient presents with a dysfunction of the tibia being posterior on the talus, the
clinician would thrust in what direction for an HVLA technique?
a) Plantarflexion
b) Dorsiflexion
12) When treating cuboid dysfunction with HVLA, the thrust or “whip” is done in:
a) Dorsiflexion
b) Plantarflexion
Match the joint with the range of motion:
13) Dorsiflexion a) 5 degrees
14) Plantarflexion b) 10 degrees
15) Subtalar inversion c) 20 degrees
16) Subtalar eversion d) 50 degrees
17) Forefoot adduction
18) Forefoot abduction

OPP #17 – Counterstrain Principles & Thorax

1) The neuromusculoskeletal system accounts for what percentage of the total body?
a) 35%
b) 50%
c) 60%
d) 70%
e) 80%
2) In what year did A. T. Still “flung the banner of osteopathy to the breeze?”
a) 1872
b) 1874
c) 1876
d) 1878
e) 1828
Match the following to the dysfunction:
3.1) T3-5 NSrRl a) Type I
3.2) L5 FSrRr b) Type II
3.3) T7 NSlRr c) Type III
3.4) L3-5 FSlRr d) Not a physiologic motion
3.5) T2-8 NSlRr
3.6) Occurs in extreme flexion or extension
3.7) Usually found at the apex of a group curve
3.8) Usually due to contracted large muscles
3.9) Movement in one plane limits movement in another
4) Which of Fryette’s Principles applies to the cervical spine?
a) Type I
b) Type II

DO NOT DISTRIBUTE - 33 -
Osteopathic Principles & Practice – Part 2 25Mar2009

c) Type III
d) Type I and Type II
e) Type I, Type II, and Type III
5) An epidemic of which of the following diseases took the lives of three of A. T. Still’s
children?
a) Cholera
b) Influenza
c) Smallpox
d) Meningitis
e) Typhoid Fever
6) As a general rule, counterstrain tender points are:
a) Treated in flexion for the posterior tender points
b) Treated in extension for the posterior tender points
c) Too tender to palpate
d) Too numerous to count
e) Located on the anterior part of the body only
7) Counterstrain was discovered accidentally by which of the following?
a) A. T. Still
b) Eileen DiGiovanna
c) Fred Mitchell, Jr.
d) Fred Mitchell, Sr.
e) Lawrence Jones
A 32-year-old female presents to your office with a chief complaint of pain in her chest
following a hard day of lifting work. She denies shortness of breath, chest pressure, or
diaphoresis. You examine her and locate a tender point on the sternum at the level of the
junction of the second rib.
8.1) This represents which anterior counterstrain tender point?
a) T1
b) T2
c) T3
d) T4
e) T5
8.2) The tender point would be treated in which position?
a) Cervical flexion to the shoulders
b) Shoulder abduction and internal rotation
c) Slight cervical extension
d) Slight cervical flexion
e) Shoulder abduction and external rotation
8.3) As you palpate this patient, you feel the first layer, which blends with the skin. This
is which layer?
a) Superficial fascia
b) Deep fascia
c) Dura
d) Subserous fascia

DO NOT DISTRIBUTE - 34 -
Osteopathic Principles & Practice – Part 2 25Mar2009

8.4) You examine her further and find a tender point halfway between the shoulder and
the neck, posterior to the trapezius. You decide to use counterstrain. In which position
would you place the patient?
a) Shoulder abducted and externally rotated
b) Shoulder abducted and internally rotated
c) Shoulder extended and externally rotated
d) Shoulder extended and internally rotated
8.5) The fascia around the trapezius muscle is:
a) Superficial fascia
b) Deep fascia
c) Dura
d) Subserous fascia
8.6) The proper way to perform the procedure on this patient would be:
a) Leave the patient for a half hour while the body corrects itself
b) Hold for 90 seconds while maintaining constant pressure on the point while
you monitor the point and slowly return to neutral
c) Hold for 90 seconds and return to neutral slowly
d) Hold for 90 seconds and rapidly return to neutral
e) Compress for three to five seconds and return to neutral
9) A 21-year-old male is weeding the garden and is bent over for an extended period of
time. When his lumbar musculature is in a strain position, which of the following is true?
a) There is only mild tension in the strained muscle
b) The strained muscle has less proprioceptor activity
c) The proprioceptor activity in both muscles is an abnormal physiologic response
d) The antagonist muscle is in a strain position
e) The antagonist muscle has less proprioceptor activity
10) Kuchera and Kuchera identify approximately how many counterstrain tender points?
a) 48
b) 72
c) 112
d) 146
e) 214
11) Which of the following describes counterstrain osteopathic manipulative treatment?
a) Direct and active
b) Direct and passive
c) Indirect and active
d) Indirect and passive
12) Which of the following describes HVLA osteopathic manipulative treatment?
a) Direct and active
b) Direct and passive
c) Indirect and active
d) Indirect and passive
13) Which of the following describes muscle energy osteopathic manipulative treatment?
a) Direct and active
b) Direct and passive
c) Indirect and active

DO NOT DISTRIBUTE - 35 -
Osteopathic Principles & Practice – Part 2 25Mar2009

d) Indirect and passive

14) Which of the following describes soft tissue (e.g. perpendicular stretch) osteopathic
manipulative treatment?
a) Direct and active
b) Direct and passive
c) Indirect and active
d) Indirect and passive
Matching: a) Counterstrain tender point b) Travell trigger point c) Chapman point
15.1) Pain is pinpoint, sharp, and exquisitely tender
15.2) A hyper-irritable spot, usually within a taut band of skeletal muscle
15.3) Used in the treatment of somatic dysfunction
15.4) Compression can cause referred pain
15.5) Treated with circular pressure for 10-30 seconds
15.6) Used in the differential diagnosis of visceral disease
15.7) Treated generally by rounding around the point and holding for 90 seconds
15.8) Treatment is to reduce adverse sympathetic influence on a particular organ
15.9) used in the treatment of somatic dysfunction and/or viscerosomatic dysfunction
16) Licensing of osteopathic physicians in California was halted and M.D. degrees were
granted by the former Osteopathic College to nearly 6500 D.O.s for a $65 fee. The Los
Angeles College of Osteopathic Physicians and Surgeons becomes an allopathic medical
school, later affiliated with the University of California system. All this happened over
several months in which years?
a) 1960-61
b) 1961-62
c) 1962-63
d) 1963-64
e) 1964-65
17) In a dysfunctional joint that is stretched, the strained muscle will show ____
proprioception and the antagonistic muscle will show ____ proprioception activity.
a) Increased; Greatly increased
b) Increased; Greatly decreased
c) Decreased; Greatly increased
d) Decreased; Greatly decreased
18) If a patient reports a counterstrain tender point as 10 out of 10 on a pain scale, what
new pain scale value (out of 10) would indicate a successful treatment?
a) 7 or less
b) 7 or more
c) 3 or less
d) 3 or more

OPP #18 – Lumbar Counterstrain

1) What nerve innervates the latissimus dorsi muscle?
a) Long thoracic nerve
b) Spinal accessory nerve
c) Thoracodorsal nerve
d) Subscapular nerve

DO NOT DISTRIBUTE - 36 -
Osteopathic Principles & Practice – Part 2 25Mar2009

2) Which of the following does NOT describe a counterstrain tender point?

a) Tense
b) Edematous
c) Discrete
d) Radiate pain
e) Small, tender
3) How long are rib tender points held when treating with counterstrain?
a) 3-5 seconds
b) 30 seconds
c) 60 seconds
d) 90 seconds
e) 120 seconds
4) Which of the following is a contraindication for counterstrain techniques?
a) Bone spur
b) Fused vertebrae
c) Systemic infection or cancer
d) Muscle cramps
e) Previous stroke or heart attack
5) What anterior lumbar tender point(s) are located on the anterior inferior iliac spine
(AIIS)?
a) AL1
b) AL5
c) AL1 & AL5
d) AL2 – AL4
e) AL1 – AL5
6) Which of the following posterior tender point(s) is treated with the patient prone, their
ipsilateral leg bent, and their leg dropped off the table?
a) PL1-PL4
b) PL4
c) UPL5
d) LPL5
e) UPL5 & LPL5
7) Which of the following tender points is treated with the patient supine, ankles/feet
hooked together, and legs externally rotated (“frog leg”)?
a) Iliacus
b) AL1 & AL5
c) UPL5
d) LPL5
e) PL1-PL4
8) Which of the following is most associated with a positive vertebral step-off sign?
a) Spondylosis
b) Spondylolysis
c) Spondylolisthesis
9) Which of the following is associated with degenerative disc disease?
a) Spondylosis
b) Spondylolysis

DO NOT DISTRIBUTE - 37 -
Osteopathic Principles & Practice – Part 2 25Mar2009

c) Spondylolisthesis
10) What spondylolisthesis grade signifies >50% displacement and is the point at which
surgery should be considered due to possible neurological damage?
a) Grade I
b) Grade II
c) Grade III
d) Grade IV
11) A key non-neutral somatic dysfunction at L1 or L2 that is rotated left and side-bent
left (RLSL) would be caused by a ____ psoas spasm, which couples with a ____
piriformis spasm, causing a ____ oblique axis of the sacrum.
a) Left; Left; Left
b) Left; Right; Left
c) Right; Right; Right
d) Right; Left; Right
12) What dermatome most corresponds to the lateral thigh?
a) L1
b) L2
c) L3
d) L4
e) L5
13) What dermatome most corresponds to the posterior thigh and calf?
a) S5
b) S4
c) S3
d) S2
e) S1
14) Injury to what nerve root would have pain along the lateral thigh and shin, numbness
over the knee, motor weakness with quadriceps extension, and a decreased patellar
reflex?
a) L3
b) L4
c) L5
d) S1
e) S2
15) What nerve root is associated with the Achilles reflex?
a) L3
b) L4
c) L5
d) S1
e) S2
16) The straight leg raising test is used to check for compression of what nerve?
a) Femoral
b) Obturator
c) Sciatic
d) Superior gluteal
e) Inferior gluteal

DO NOT DISTRIBUTE - 38 -
Osteopathic Principles & Practice – Part 2 25Mar2009

17) The Thomas Test checks for spasm of what muscle(s)?

a) Quadratus lumborum
b) Quadriceps
c) Hamstrings
d) Iliopsoas
e) Gluteus medius
18) The Trendelenberg Test checks for strength of what muscle(s)?
a) Quadratus lumborum
b) Quadriceps
c) Hamstrings
d) Iliopsoas
e) Gluteus medius

OPP #19 – Cervical Counterstrain

1) What is the role of the suboccipital articulation (OA & AA joints) in spinal
compensation?
a) Promotes monocular vision
b) Allows for nystagmus
c) Keeps eyes level
d) Inhibits the oculocervical (oculogyric) reflex
e) Keeps the sacrum level
2) A unilateral cervical muscle spasm can cause unilateral rotation of what bone, leading
to benign cervical vertigo?
a) Parietal bone
b) Sphenoid bone
c) Temporal bone
d) Occipital bone
e) Frontal bone
3) Which of the following describes how to treat a posterior cervical tender point at the
level of C3 (PC3) with counterstrain?
a) Flexion, side-bend away, rotate away (fSARA)
b) Extension, side-bend away, rotate away (eSARA)
c) Flexion, side-bend toward, rotate away (fSTAR)
d) Extension, side-bend toward, rotate away (eSTAR)
4) Which of the following describes how to treat an anterior cervical tender point at the
level of C7 (AC7) with counterstrain?
a) Flexion, side-bend away, rotate away (fSARA)
b) Extension, side-bend away, rotate away (eSARA)
c) Flexion, side-bend toward, rotate away (fSTAR)
d) Extension, side-bend toward, rotate away (eSTAR)
5) Which of the following midline cervical tender points is treated with extension?
a) PC1
b) PC7
c) AC1
d) AC5
e) AC8

DO NOT DISTRIBUTE - 39 -
Osteopathic Principles & Practice – Part 2 25Mar2009

6) Which of the following describes how to treat a posterior cervical tender point at the
level of C5 (PC5) with counsterstrain?
a) Flexion, side-bend away, rotate away (fSARA)
b) Extension, side-bend away, rotate away (eSARA)
c) Flexion, side-bend toward, rotate away (fSTAR)
d) Extension, side-bend toward, rotate away (eSTAR)
7) Which cervical counterstrain tender point is found within the trapezius muscle?
a) AC7
b) AC8
c) PC7
d) PC8
8) Which of the following describes the location of the anterior cervical tender points at
the level of C7 and C8?
a) AC7 and AC8 lie on top of each other
b) AC7 is located medial to AC8
c) AC8 is located medial to AC7
d) AC7 is located caudad to AC8
e) AC8 is located caudad to AC7

James Lamberg

DO NOT DISTRIBUTE - 40 -
Osteopathic Principles & Practice – Part 2 25Mar2009

AnswerKey 2) A 15) B 42) B 2) C

OPP #1 3) B 16) C 43) A 3) B
1) F 4) C 17) B 44) D 4) D
2) B 5) E 45) C 5) E
3) D 6) D OPP #5 46) E 6) A
4) A 7) C 1) D 7) C
5) C 8) A 2) C OPP #6 8) C
6) C 9) D 3) E 1) D
7) B 10) A 4) A 2) D OPP #9
8) D 11) B 5) B 3) A 1) B
9) C 12) C 6) C 4) E 2) D
10) A 13) C 7) A 5) B 3) D
11) E 14) C 8) E 6) C 4) B
12) B 15) D 9) D 7) D 5) E
13) E 16) A 10) B 8) D 6) B
14) B 17) B 11) A 9) C 7) C
15) D 18) D 12) C 10) D 8) A
16) F 19) A 13) C 11) E 9) C
17) A 20) C 14) C 12) A 10) C
18) C 21) B 15) D 13) A 11) E
19) A 22) B 16) D 14) E 12) D
20) B 23) A 17) E 15) C 13) C
21) C 24) A 18) C 16) B
22) E 25) A 19) D 17) D OPP #10
23) B 26) B 20) A 18) C 1) D
27) C 21) B 19) E 2) C
OPP #2 28) D 22) C 20) D 3) B
1) E 29) A 23) B 21) D 4) E
2) C 30) B 24) C 22) B 5) A
3) B 31) E 25) A 23) A 6) A
4) D 26) B 24) C 7) A
5) C OPP #4 27) A 8) D
6) B 1) C 28) D OPP #7
7) D 2) D 29) B 1) E OPP #11
8) A 3) A 30) E 2) B 1) C
9) D 4) D 31) A 3) D 2) C
10) C 5) D 32) C 4) C 3) B
11) A 6) E 33) D 5) E 4) D
12) D 7) B 34) C 6) B 5) B
13) B 8) A 35) D 7) C 6) B
14) B 9) B 36) E 8) C 7) E
15) E 10) B 37) B 9) E 8) A
16) A 11) E 38) C 10) B 9) C
12) D 39) E 10) A
OPP #3 13) C 40) A OPP #8
1) E 14) A 41) F 1) D

DO NOT DISTRIBUTE - 41 -
Osteopathic Principles & Practice – Part 2 25Mar2009

OPP #12 4) C 10) D 8) C

1) D 5) E 11) D
2) E 12) B
3) B OPP #16 13) A
4) C 1) B 14) B
5) A 2) D 15.1) C
6) B 3) B 15.2) B
7) B 4) D 15.3) A
8) D 5) B 15.4) B
9) E 6) E 15.5) C
10) E 7) A 15.6) C
11) D 8) D 15.7) A
12) A 9) A 15.8) C
13) D 10) C 15.9) A
14) B 11) B 16) B
15) C 12) B 17) A
16) F 13) C 18) C
17) B 14) D
18) C 15) A OPP #18
16) A 1) C
OPP #13 17) C 2) D
1) A 18) B 3) E
2) C 4) C
3) C OPP #17 5) D
4) A 1) C 6) D
5) D 2) B 7) A
6) A 3.1) A 8) C
7) D 3.2) B 9) A
3.3) D 10) C
OPP #14 3.4) D 11) B
1) D 3.5) A 12) B
2) C 3.6) B 13) D
3) C 3.7) B 14) B
4) B 3.8) A 15) D
5) B 3.9) C 16) C
6) C 4) C 17) D
7) A 5) D 18) E
8) B 6) B
9) D 7) E OPP #19
10) B 8.1) B 1) C
11) B 8.2) A 2) C
8.3) A 3) C
OPP #15 8.4) A 4) C
1) D 8.5) B 5) B
2) A 8.6) C 6) B
3) C 9) E 7) D

DO NOT DISTRIBUTE - 42 -